Abstract

Background: There is much controversy about the ideal approach to the management of community acquired pneumonia (CAP). Recommendations
differ from a pathogen directed approach to an empirical strategy with broad spectrum antibiotics.

Methods: In a prospective randomised open study performed between 1998 and 2000, a pathogen directed treatment (PDT) approach was
compared with an empirical broad spectrum antibiotic treatment (EAT) strategy according to the ATS guidelines of 1993 in 262
hospitalised patients with CAP. Clinical efficacy was primarily determined by the length of hospital stay (LOS). Secondary
outcome parameters for clinical efficacy were assessment of therapeutic failure on antibiotics, 30 day mortality, duration
of antibiotic treatment, resolution of fever, side effects, and quality of life.

Results: Three hundred and three patients were enrolled in the study; 41 were excluded, leaving 262 with results available for analysis.
No significant differences were found between the two treatment groups in LOS, 30 day mortality, clinical failure, or resolution
of fever. Side effects, although they did not have a significant influence on the outcome parameters, occurred more frequently
in patients in the EAT group than in those in the PDT group (60% v 17%, 95% CI −0.5 to −0.3; p<0.001).

Conclusions: An EAT strategy with broad spectrum antibiotics for the management of hospitalised patients with CAP has comparable clinical
efficacy to a PDT approach.